老年局部晚期头颈部鳞癌非手术治疗研究进展  

Review on non-surgical treatment for elderly patients with locally advanced head and neck squamous cell carcinoma

作　　者：何姗珊 李厨荣 陈思皓 邵世龙 钟祖鲜 王丹 刘刈 张石川 He Shanshan;Li Churong;Chen Sihao;Shao Shilong;Zhong Zuxian;Wang Dan;Liu Yi;Zhang Shichuan(College of Clinical Medicine,Southwest Medical University,Luzhou 646000,China;Department of Radiation Oncology,Sichuan Cancer Hospital&Institute,School of Medicine,University of Electronic Science and Technology of China,Sichuan Cancer Center,Radiation Oncology Key Laboratory of Sichuan Province,Chengdu 610041,China;School of Medicine,University of Electronic Science and Technology of China,Chengdu 610041,China;School of Clinical Medicine,Chengdu Medical College,Chengdu 610041,China)

机构地区：[1]西南医科大学临床医学院,泸州646000 [2]电子科技大学医学院附属肿瘤医院,四川省肿瘤医院·研究所放疗中心,四川省癌症防治中心,放射肿瘤学四川省重点实验室,成都610041 [3]电子科技大学医学院,成都610041 [4]成都医学院临床医学院,成都610041

出　　处：《中华放射肿瘤学杂志》2023年第2期169-173,共5页Chinese Journal of Radiation Oncology

基　　金：成都市科技局科技项目(2021-YF05-02390-SN)。

摘　　要：随着人口老龄化,老年(≥65岁)肿瘤患者已经成为临床主体患者人群之一。对于无法手术的局部晚期头颈部鳞癌,以顺铂为基础的同步放化疗是一线治疗方案。多个大型临床研究表明,<70岁患者可以从同步放化疗中获益,70~80岁的患者存在争议,选择化疗时需慎重。对于顺铂不能耐受的老年患者,可以选用卡铂或尝试其他消化道及肾不良反应较小的化疗方案。西妥昔单抗等抗表皮生长因子受体(EGFR)单抗联合放疗尽管在整体人群中优于单纯放疗,但年龄亚组分析显示老年患者获益有限。新兴的免疫检查点抑制剂在老年患者中的安全性已得到证实,程序性死亡蛋白配体-1(PD-L1)高表达的老年患者可能从同步放疗或新辅助治疗中获益,但相关的高级别临床证据仍然缺乏。对于>80岁的高龄患者,单纯放疗可能优于同步放化疗,以姑息治疗为目的的低分割/大分割放疗可安全用于这部分人群。With the aging of population,the elderly(≥65 years old)cancer patients have become one of the main populations for cancer care.For inoperable locally advanced head and neck squamous carcinomas,cisplatin-based concurrent chemoradiotherapy is the first-line choice.Several large clinical studies have shown that patients under 70 years of age can still benefit from concurrent chemoradiotherapy,while it should be cautious to apply chemotherapy to patients aged 70-80 years.For elderly patients who are intolerant to cisplatin,carboplatin or other regimens with less gastrointestinal and renal toxicity should be considered.Although anti-epidermal growth factor receptor(EGFR)monoclonal antibodies combined with radiotherapy has been proved to be more effective than radiotherapy alone in total patient population,age-subgroup analysis showed limited benefit in elderly patients.The safety of immune checkpoint inhibitors in elderly patients has been validated and those with high programmed death ligand-1(PD-L1)expression may benefit from concurrent or neoadjuvant immunotherapy,however,high-level evidence is still lacking.For patients older than 80 years,radiotherapy alone may be superior to concurrent chemoradiotherapy,and hypofractionated radiotherapy for palliative purposes can be safely used in this population.

关 键 词：头颈部鳞癌 老年患者 放化疗法 靶向治疗 免疫疗法 

分 类 号：R739.91[医药卫生—肿瘤]